Healthcare Provider Details

I. General information

NPI: 1386131498
Provider Name (Legal Business Name): MICHELLE URATA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N STATE COLLEGE BLVD STE G
ANAHEIM CA
92806-2932
US

IV. Provider business mailing address

5232 CHRISTAL AVE
GARDEN GROVE CA
92845-2329
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-6496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number293051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: